Nursing Clio

In the past few days, Americans (and I am sure many people around the globe) have read Angelina Jolie’s startling announcement that she recently underwent a preventative double mastectomy and reconstructive surgery (and as I understand she will also have her ovaries removed).  Like most people, I was awestruck by her bravery, her straightforwardness, and her honesty. As a scholar of medicine and gender and women’s history, I was instantly struck by how her melodic narrative described her agency as both a patient and a woman. Her op-ed also conveyed a dream of perfect medical care, family support, and clarity in making a very profound decision that would have a major impact on her future health. But as much as I marveled at her decisions (as did so many other individuals), my academic training immediately brought a level of cynicism that I could not easily dismiss (and I am not alone). I almost instantly began to think about Angelina Jolie the celebrity, not Angelina Jolie the common woman. Her status and privilege allowed her to have what seemed to be an almost ideal experience under the circumstances, or what I like to call the Jolie Treatment, which the Pink Lotus Breast Clinic has showcased on  their website. Pink Lotus and Jolie obviously see her experience as a way to educate women to the options available to prevent or treat this horrible disease. Jolie will undoubtedly become a spokesperson for breast cancer prevention, and to be honest, I can think of no one better suited to bring this message to thousands of women. But what the Jolie Treatment ignores or downplays to a considerable minimum is that celebrity healthcare is expensive. If Jolie is going to take the lead, then she has to concede and even battle against the disparity between wealth and health in the U.S and the profound impact this has on women’s healthcare.

Public acknowledgement of celebrities and their battles with various illnesses is not new. Barron H. Lerner discussed this connection extensively in When Illness Goes Public: Celebrity Patients and How We Look at Medicine, which is a fascinating account of how the general public learns about medicine through celebrities’ experiences with particular diseases. He traces how celebrities’ health and illnesses can fuel interest and impart knowledge while also raising fears, changing perceptions, and creating myths about particular diseases and treatments. For the most part, celebrities bring a positive light to illness and create support and advocacy for treatment. But what is missing in most, if not all, of the celebrity accounts, whether successful or not, is the cost associated with illness.

The cost of medical care has been a concern in America since the early twentieth century. As medicine advanced, its prices rose. Doctors and reformers worried that good medical care was out of reach for many Americans. The exponential rise in health care costs, due to medicine’s increased efficacy, the growing number of specialties, and scientific and technological advancements, limited the average person’s access to quality care. Beatrix Hoffman points out in her new book, Health Care for Some: Rights and Rationing in the United States since 1930, that the rising cost of medical care has been one of the major reasons for the rationing of health care in the U.S., something most Americans subconsciously hate, but consciously ignore or remain silent about.[1]

At the same time, Jolie’s op-ed reflects that the discussion about breast cancer and cancer in general, is no longer stigmatized. There was a time when cancer was a word you whispered. But in the last forty years, breast cancer patients and survivors stopped whispering. Women took a much more active role in deciding how to proceed with treatment. In these last thirty years, breast cancer has become pinkified, commercialized, and more medicalized as better detection, less evasive procedures, and preventative measures developed. In all, new medical care for breast cancer and advocacy has allowed a sense of pride, not shame, to be a part of the prevention and the treatment of breast cancer.[2]

But as with so many other medical illnesses, breast cancer is expensive to prevent, treat, and battle. Pink Lotus, to their credit, offers uninsured women opportunities for the same treatment that Jolie and other wealthy women receive, but like so many private or public altruistic endeavors in history, there is a selection process to determine whether or not these women are deemed worthy enough to receive red carpet treatment. This very much reflects what Hoffman found in her work, that the rationing of and the right to healthcare is determined by those in power, i.e. government officials, insurance companies, and doctors, which leaves so many of those marginalized wondering if they will receive the care they need. Pink Lotus may state that all women have the right to red carpet medical care when it comes to breast cancer, but is this the reality? The answer is no, because even if you are given that right, there are many more costs than just paying for the surgeries.

Now, Jolie does mention the cost of the BRAC test (which is patented by one company), but then glossed over the rest. There is no mention of the expenses she and Brad incurred, if any. But the Jolie Treatment does not just include breast removal and reconstruction done by the best doctors. It also incorporates a massive support system. In order for all women to have the right to red carpet healthcare (which really shouldn’t all health care be red carpet?), then all women don’t just need money and insurance, but also the other resources Jolie highlighted in her op-ed, which include the supportive partner/spouse, family, an understanding employer, reliable transportation and childcare, and “time” in general. Jolie invited us to see the decisions a woman can make over her body and how powerful that can be, but at the same time, she had the opportunity and those choices because she had access to unlimited resources. I really wish she had blatantly acknowledged that her wealth and privilege allowed her to prevent a horrible disease, not weakly admit that, yes, genetic testing is expensive, and that it is hard for many women to receive proper care (but that shouldn’t stop you!).

If she is going to become a spokesperson (which maybe she is not) then she must recognize that many women in the U.S. will have neither the money nor the time and support to prevent, to battle, or even to reconstruct a region of the body with “beautiful results.” Many women must make choices on a daily basis that influence their medical well-being. The Jolie Treatment might be the red carpet medical care that every woman should have, but in reality, most will never get to walk on or down that red carpet.